Neurology & Pain Management Coding Alert

Question:

Illinois Subscriber

Keep several things in mind when selecting codes for this scenario, beginning with a clear understanding of what the codes include. You are correct in that if your neurologist is performing both the professional and technical components of the electrodiagnostic testing, you would bill the diagnostic studies as global services and not append any modifiers unless circumstances dictate otherwise.

For example, if the neurologist performs an EMG on one arm in his office, you should bill 95860 (Needle electromyography' 1 extremity, with or without related paraspinal areas). If he performs the same test in a hospital setting, bill 98560 with modifier 26 (Professional component) because your physician performed the diagnostic study in a facility site of service. Many payers consider the technical component of all diagnostic studies to be part of the facility's payment and not payable to the physician.

Modifier check: If your physician performs a motor nerve conduction study (NCS) and an F wave study on the same nerve, only report 95903 (Nerve conduction, amplitude and latency/velocity study, each nerve; motor, with F-wave study) with one unit of service. However, if your neurologist performs a motor NCS without F-wave and also a motor NCS with F-wave on a different nerve during the same session, report both diagnostic studies. You would need to append modifier 59 (Distinct procedural service) to the 95900 (Nerve conduction, amplitude and latency/velocity study, each nerve; motor) code to identify it as a separate and distinct diagnostic study from the 95903 code.

Remember: Your physician must study a minimum of five muscles per each extremity before you can submit EMG extremity codes 95860-95864 (Needle electromyography ...).